Skin closure systems and devices of improved flexibility and stretchability for bendable joints

ABSTRACT

A system or device for skin closure comprises an elastic flat flexible tape elongated along a longitudinal axis and having a lower side and an opposing upper side, said tape having a pressure sensitive adhesive on at least a portion of the lower side, said tape having a plurality of openings arranged side-by-side with spaces between said openings oriented across the longitudinal axis.

The present disclosure relates to skin closure systems and devicescomprising elastic flat flexible tape elongated along a main axis andhaving a lower side and an opposing upper side, said tape having apressure sensitive adhesive on at least a portion of the lower side,said tape having a plurality of openings arranged side-by-side withspaces between said openings oriented across the main axis. Skin closuredevice is applied over a surgical incision and secured by polymerizableadhesive.

BACKGROUND

A number of devices and methods exist for closing skin or tissue havinga surgical opening, cut, wound, or dissection, whereby skin or tissueparts separated by the cut are approximated or brought into closeproximity forming as narrow gap as possible in the area of the surgicaldissection or cut, and then covered by an adhesively attached tape whichholds the skin or tissue in closed apposed arrangement until woundhealing whereby the tape is removed.

Commercially available DERMABOND® PRINEO® Skin Closure System comprisesa mesh having a pressure sensitive adhesive and a polymerizationinitiator disposed on the mesh. The mesh is applied onto the skin over awound, and a polymerizable cyanoacrylate based adhesive is then appliedon the mesh and bonds the mesh to the skin. However, skin closuresystems, such as DERMABOND® PRINEO® Skin Closure System, may benefitfrom more stretching for flexibility/joint articulation if applied overa joint, such as knee, elbow, or similar, while holding the dissectionapplied lengthwise or longitudinally along the joint.

A number of attempts to address this issue are known, includingcommercial products: such as TopClosure® 3S System—Skin Stretching andSecure Wound Closure System; Steri-Strip™ by 3M™; Zip®16 Surgical SkinClosure by Zipline Medical. These known systems are complex and eitherlack flexibility or lack secure and lasting bonding and coverage whichextends for the time needed for full healing, such as 1-2 weeks.

PCT publication No. WO2008/082444 titled “Articles and Methods forTissue Repair” discloses a method of medically treating a tissuecomprising: directing a transfer device to a tissue surface, thetransfer device having associated therewith a patterned array of anadhesive; transferring at least a portion of the patterned array ofadhesive from the transfer device to the tissue surface by contactadhesion; moving the transfer device away from the tissue surface;positioning an article to be adhered adjacent at least a portion of theadhesive; and adhering the article to the tissue surface using theadhesive.

U.S. Pat. No. 8,353,966 entitled “Scaffold for Bone and Tissue Repair inMammals” discloses a tissue scaffold for repair and regeneration of bonehard tissue or muscle, skin, or organ soft tissue, the scaffoldcomprising: a rigid scaffold body having a scaffold central axis, ascaffold transverse dimension, and a scaffold lengthwise dimension whichis greater than the scaffold transverse dimension, the scaffold bodyhaving a compressive strength between about 20 and about 250 MPa andcomprising: biocompatible inorganic glass fibers each having a fibertransverse dimension and a fiber lengthwise dimension which is at leastabout 10 times the fiber transverse dimension; and an interconnectedporosity constituting between about 10 vol. % and about 35 vol. % of thescaffold body; wherein each of the fibers has a diameter between about20 and about 5000 microns; wherein at least about 75 vol. % of thefibers are longitudinally co-aligned and lie generally lengthwise of thescaffold central axis, are generally free of helical orientation aboutthe scaffold central axis, and are arranged to define open channelswithin the scaffold which allow fluid flow into and lengthwise withinthe scaffold; and wherein the fibers are self-bonded together in thatadjacent longitudinally aligned fibers are fused together.

U.S. Pat. No. 6,652,559 entitled “Wound Closure System” discloses awound closure system for closing a wound on a patient, comprising: anelongated flexible backing strip having opposite ends, first and secondsurfaces facing away from one another and a length and width sufficientto secure facing edges of the wound in close juxtaposition to oneanother, said backing strip comprising a first portion disposed betweensaid ends and adapted to overlie the facing edges of said wound, andsecond and third portions disposed on either side of said first portionand each provided with a predetermined number of spaced-apartperforations extending through said backing strip from said firstsurface to said second surface, said first portion being free of anyaperture extending through said backing strip from said first surface tosaid second surface; a first pressure-sensitive adhesive coated on atleast part of the first surface of said backing strip including saidsecond and third portions thereof, to adhere at least said second andthird portions of said backing strip to the patient with the facingedges of said wound in said close juxtaposition; a first protectivemember removably attached to said backing strip and covering saidpressure-sensitive adhesive; and a flowable, moisture-curable surgicaladhesive for application into said perforations to strengthen theadhesion of said second and third portions of said backing strip to thepatient; whereby after (a) removal of said protective member to exposesaid pressure-sensitive adhesive, (b) application of said backing stripwith the exposed pressure-sensitive adhesive onto said patient to securethe facing edges of said wound in said close juxtaposition, and (c)application of said surgical adhesive into said apertures, said surgicaladhesive flows through said perforations and upon curing forms discretebonding sites cooperating with said backing strip to maintain the facingedges of said wound in said close juxtaposition without the curedadhesive adversely affecting the flexibility of said backing strip,wherein a second protective member having a second pressure-sensitiveadhesive coated on one side thereof is removably attached to saidbacking strip and covers said second surface, said strip being disposedbetween said first and second protective members, and wherein saidsecond protective member is provided with a corresponding number ofperforations registering with the perforations defined in said secondand third portions of said backing strip, and being in flowcommunication therewith.

U.S. Pat. No. 6,559,350 entitled “MOISTURE-CURABLE ADHESIVE SUTURESTRIP” discloses a moisture-curable adhesive suture strip for closing awound on a patient, comprising: an elongated, flexible air-permeablebacking member formed of a chemically inert material, and havingopposite ends, first and second surfaces facing away from one anotherand a length and width adapted to secure facing edges of the wound inclose juxtaposition to one another, said backing member comprising afirst portion disposed between said ends and adapted to overlie thefacing edges of said wound, and second and third portions disposed oneither side of said first portion; a moisture-curable surgical adhesiveon at least part of the first surface of said backing member includingsaid second and third portions thereof, in spaced-apart discrete areasof said first surface; a pressure-sensitive adhesive on the firstsurface of said backing member between said discrete areas for adheringat least said second and third portions of said backing member to thepatient with the facing edges of said wound in said close juxtaposition;and a first removable protective member formed of a chemically inertmaterial releasably secured to said backing member and covering saidsurgical adhesive and said pressure-sensitive adhesive; whereby afterremoval of said protective member to expose said surgical adhesive andsaid pressure sensitive adhesive, and application of said backing memberwith the exposed surgical adhesive pressure sensitive adhesive onto saidpatient to secure the facing edges of said wound in said closejuxtaposition, said surgical adhesive upon curing forms discrete bondingsites strengthening the adhesion of at least said second and thirdportions of said backing member to the patient and cooperating with saidbacking member to maintain the facing edges of said wound in said closejuxtaposition without the cured adhesive adversely affecting theflexibility of said backing member.

U.S. Patent Application Publication No. 2013/0012988 entitled “WoundClosure Material” discloses wound closure material with a core ofbiodegradable material, wherein at least one side of the core ofbiodegradable material is provided with a multitude of discrete spots ofan adhesive and the core of biodegradable material comprises an opencell structure.

U.S. Pat. No. 8,642,831 entitled “Device for Promotion of Hemostasisand/or Wound Healing” discloses a hemostatic matrix material comprisinga surface and a plurality of open and interconnected cells, said matrixmaterial comprising gelatine or collagen, wherein the surface of saidmatrix comprises at least one pharmaceutical composition printed ontosaid surface in individual and discrete locations, wherein saidpharmaceutical composition comprises one or more hemostatic agents.

U.S. Patent Application publication No. 2014/0155916 entitled“Multi-layer Porous Film Material” discloses a surgical implant,comprising: a first porous film layer including a plurality of pores;and a second porous film layer including a plurality of pores, the firstand second porous film layers being in a stacked configuration andinterconnected to one another at a plurality of attachment points todefine at least one void between the first and second porous filmlayers.

U.S. Patent Application publication No. 2008/0109034 entitled“Controlled Adhesive Locations Facilitating Tissue Remodeling” disclosesa surgical implant for adhering two portions of tissue togethercomprising; a) an implantable matrix having at least one layer and aplurality of openings formed within the at least one layer for tissuegrowth therethrough; and b) a polymer adhesive about the implantablematrix for adhering the two portions of tissue together, the adhesivepolymerizing to adhere the tissue together when the two portions oftissue are brought together.

U.S. Patent Application publication No. 2006/0141012 entitled “TissueScaffold” discloses a tissue scaffold comprising: a first film includinga plurality of cell openings; and a second film adjacent the first filmand including a plurality of cell openings larger than the cell openingsof the first film; wherein the cell openings of the first filminterconnect with the cell openings of the second film to definepathways extending from the first film to the second film.

U.S. Patent Application publication No. 2013/0204077 entitled “SurgicalScaffolds” discloses a surgical scaffold for soft tissue repair, saidsurgical scaffold comprising a sheet of non-filamentous polymericmaterial, at least a portion of the sheet surface comprising a pluralityof through-holes.

Leukosan® SkinLink by BSN Medical and distributed by Smith and NephewPty Ltd, has an apertured band-aid like structure.

Synthetic tissue adhesive TissuGlu® Surgical Adhesive by Cohera Medical,Inc. is based on a polyurethane prepolymer and is applied in a spot-likediscrete application of the adhesive during abdominoplasty, using amulti-point dispenser.

Very flexible and elastic tapes will allow for joint flexibility, butwill not hold the skin areas in apposed arrangement due to the sameelasticity, potentially resulting in wound dehiscence or surgicalcomplication in which a wound ruptures along a surgical incision. Otherknown systems fail to fully cover the wound resulting in potential foringress of contaminants and infection causing microorganisms. Otherknown systems are overly rigid preventing articulation or bending of thejoint.

There continues to be a need for improved devices, systems, and methodsfor holding skin areas around the dissection in apposed arrangementwhile still providing for flexibility in longitudinal direction enablingbending of the underlying joints.

SUMMARY OF THE INVENTION

In one embodiment, a device for skin closure comprises an elastic flatflexible tape elongated along a main axis and having a lower side and anopposing upper side, said tape having a pressure sensitive adhesive onat least a portion of the lower side, said tape having a plurality ofopenings arranged side-by-side with spaces between said openingsoriented across the main axis.

According to another embodiment, there is provided a method of skinclosure, comprising the steps of disposing the device onto skin having asurgical incision with the main axis approximately aligned with thesurgical incision; apposing and approximating edges of the incision toeach other; using the pressure sensitive adhesive to fixate the deviceon skin; applying a polymerizable adhesive onto the upper side into theopenings; Allowing the polymerizable adhesive to polymerize and bond toskin and to the device; rendering the device substantially notstretchable in the directions perpendicular to the main axis butstretchable along the main axis providing for flexibility and enablingbending of underlying joints; providing coverage of the incision andkeeping the incision closed.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A-D show applications of an embodiment of the device of the skinclosure system to a joint in schematic side and top views.

FIGS. 2A-E show embodiments of the skin closure device in schematic topview and cross-sectional side views.

FIGS. 3A-B show embodiments of the skin closure device in a schematictop view and a cross-sectional side view.

FIGS. 4A-B show an embodiment of the skin closure device in a schematictop view and cross-sectional side view.

FIG. 5 shows an embodiment of the skin closure device in a schematic topview.

FIGS. 6A-C show embodiments of the skin closure device in schematic topviews.

FIGS. 7A-B show embodiments of the skin closure device in schematic topviews.

FIGS. 8A-C show embodiments of the skin closure device in schematic topviews.

FIGS. 9A-B show embodiments of the skin closure device in schematic topviews.

FIGS. 10A-B show embodiments of the skin closure device in schematic topviews.

FIGS. 11A-B show embodiments of the skin closure device in schematic topviews.

FIG. 12 shows an embodiment of the skin closure device in a schematictop view.

DETAILED DESCRIPTION

Referring now to FIG. 1, a schematic cross-sectional view of a joint100, such as knee or elbow (knee is shown), with an embodiment of device10 applied over the joint 100, which is not bent, as seen in FIG. 1A, orbent as shown in FIG. 1B. FIG. 1C shows joint 100 in top view, with thesurgical incision or wound 110 present and directed along the limbhaving joint 100. FIG. 1D shows joint 100 in top view, with anembodiment of device 10 of the present invention applied to joint 100and fully covering surgical incision or wound 110. Device 10 iselongated and applied along the limb having joint 100 and along surgicalincision or wound 110.

Referring now to FIG. 2, embodiments of Skin Closure System device 10are shown, with device 10 comprising a thin, flat, flexible and elastictape 20 having length L and width W and elongated along axis 21, withupper side 22 and lower side 23, with tape 20 having a plurality ofopenings 30 each spanning a large portion of the width W of tape 20 orthe whole width W (as shown, e.g., in FIG. 3), with openings 30 arrangedside by side along the length L and separated by spacer areas 35.Openings 30 are fully covered by porous mesh 40 preferably having aninitiator or accelerator of polymerization disposed on the mesh 40,coated on the mesh 40, and/or impregnated into the mesh 40. Preferably,initiator or accelerator of polymerization is disposed, coated, orimpregnated onto/into at least openings 30 or mesh present in opening30, or onto whole tape 20.

FIG. 2A shows the top view of device 10 while FIGS. 2B, 2C, 2D showcross-sectional views of different constructions corresponding to topview 2A. According to an embodiment of device 10 shown in FIG. 2B, mesh40 has the thickness similar to thickness T of tape 20, with meshpresent within openings 30. As used herein, the term “present” meansthat the mesh is exposed or disposed or positioned within openings 30.According to an embodiment of device 10 shown in FIG. 2C, mesh 40 hasthickness which is lower than thickness T of tape 20, with mesh presentwithin openings 30. According to an embodiment of device 10 shown inFIG. 2D, mesh 40 is disposed on a lower surface of tape 20.

Mesh 40 alternatively can be a porous nonwoven, felt, porous wovenfabric, textile, foam, or similar. Mesh 40 can also be an extruded filmporated during or after extrusion or formed directly with apertures.

Tape 20 is made of a polymeric flexible and elastic material. Elasticproperty is defined by stretchability at least in the lengthwisedirection, with stretchability from 1% to 50% of length when exposed to1 N of force, more preferably 3%-25% of the initial or unstressedlength. The ‘elastic’ property is a function of the material from whichthe mesh is constructed and/or the nature of the mesh constructionitself. Mesh 40 is made of flexible material, which can optionally alsobe elastic. Mesh 40 can be polymeric, metal, ceramic, natural fiber,etc., with preferable material being polymeric. Lower side 23 hasoptionally a pressure sensitive adhesive (PSA) disposed thereon, whichcan cover the whole lower side 23, or only a portion of lower side 23 inany pattern. In one embodiment, PSA is applied in equally spaced stripesacross whole lower side 23. In another embodiment, PSA is applied onlyon the areas free of openings 30 on lower side 23. In anotherembodiment, PSA is applied only on the areas where openings 30 arepresent on lower side 23 and optionally above and below openings 30. Inyet another embodiment, PSA is applied uniformly everywhere on lowerside 23. FIG. 2E shows PSA 45 disposed on tissue facing or wound facinglower side 23. PSA can be on tape 20 and/or on mesh 40.

In use and referring to FIG. 2, device 10 is disposed on tissue or skinhaving a wound with axis 21 approximately aligned with the surgicalincision or wound, with the edges of the incision apposed andapproximated to each other. A polymerizable adhesive is then appliedonto upper side 22, onto the whole upper side 22 surface or morepreferably only onto/into openings 30 on upper side 22. If an initiatoror accelerator is present, the polymerizable adhesive reacts with theinitiator or accelerator of polymerization disposed on the mesh 40,coated on the mesh 40, and/or impregnated into the mesh 40 resulting inpolymerization and bonding of the adhesive to the skin or tissue in theareas corresponding to openings 30 and to the device 10. Bonding todevice 10 is at least in part due to bonding to mesh 40 disposed withinopenings 30.

The application of adhesive results in device 10 being bonded to theskin and covering the wound or incision while holding skin areas aroundthe dissection in apposed arrangement. Due to presence of the adhesive,device 10 is substantially not stretchable in the directionsperpendicular to axis 21, keeping the wound or incision closed and skinareas around the dissection in apposed arrangement. At the same timedevice 10 is stretchable along the main axis providing for flexibilityin longitudinal direction enabling bending of the underlying joints,while also providing coverage of the wound or incision. Advantageously,wound dehiscence or surgical complication in which a wound rupturesalong a surgical incision is therefore prevented, while also fullycovering the wound and enabling articulation or bending of the joint.

Referring now to FIGS. 3A and 3B, embodiments of Skin Closure Systemdevice 10 similar to the embodiments of FIG. 2 are shown, with pluralityof openings 30 each spanning the whole width of tape 20, with openings30 arranged side by side along the length of tape 20 and separated byspacer areas 35. According to an embodiment of device 10 shown in FIG.3B showing a cross-sectional view, mesh 40 is disposed on a lowersurface of tape 20.

According to an embodiment (not shown), there is provided a kit,comprising device 10, a container containing a polymerizable orcross-linkable liquid adhesive, and a dispenser adapted to dispenseadhesive. In one embodiment, dispenser has a tip for expressing thepolymerizable adhesive, wherein the tip has a width equal to a width ofopenings 30.

Referring now to FIGS. 4A and 4B, embodiments of Skin Closure Systemdevice 10 similar to the embodiments of FIGS. 2,3 are shown, but withopenings 30 comprising areas of porated or perforated tape 20, with nomesh 40 used to form device 10 of this embodiment. Preferably, initiatoror accelerator of polymerization is disposed, coated, or impregnatedonto/into at least openings 30 comprising areas of porated or perforatedtape 20 or onto whole tape 20.

No Mesh

Referring now to FIG. 5, an embodiment of Skin Closure System device 10similar to the embodiments of FIGS. 2, 4 are shown, but with openings 30comprising areas of material removed from tape 20, with no pores or meshwithin openings 30, i.e., openings 30 comprising cut-outs or holes withno material disposed within openings 30. In use, this embodiment ispreferably utilized with an adhesive dispenser which has initiator oraccelerator of polymerization admixed into the adhesive upon dispensing,such as from a porous tip impregnated with initiator or accelerator ofpolymerization.

In use and referring to FIG. 5, device 10 is disposed on tissue or skinhaving a wound with axis 21 approximately aligned with the surgicalincision or wound, with the edges of the incision apposed andapproximated to each other. A polymerizable adhesive is then appliedonto upper side 22 onto the whole upper side 22 surface or morepreferably only onto/into openings 30 on upper side 22. Thepolymerizable adhesive is dispensed from a porous tip impregnated withinitiator or accelerator of polymerization, reacts with the initiator oraccelerator of polymerization, if present, resulting in polymerizationand bonding of the adhesive to the skin or tissue in the areascorresponding to openings 30 and to the device 10. The application ofadhesive results in device 10 being bonded to the skin or tissue in theareas corresponding to openings 30 and covering the wound or incisionwhile holding skin areas around the dissection in apposed arrangement.Due to presence of the adhesive, device 10 is substantially notstretchable in the directions perpendicular to axis 21, keeping thewound or incision closed and skin areas around the dissection in apposedarrangement. At the same time device 10 is stretchable along the mainaxis providing for flexibility in longitudinal direction enablingbending of the underlying joints.

Mask

Referring now to FIG. 6, an embodiment of Skin Closure System device 10similar to the embodiments of FIGS. 2A, 2D is shown. FIG. 6A showsassembled device 10 which comprises tape 20 a shown in FIG. 6B,representing a removable mask 20 a which is made of a polymeric flexiblematerial which can be optionally non-elastic or elastic, with mask 20 areleasably disposed on mesh 40 a shown in FIG. 6C, with mesh 40 a madeof polymeric flexible and elastic material. Mask 20 a is attached tomesh 40 with a weak PSA disposed on mask 20 a (not shown) or by acompression fit or by any other method known in the art assuring easyrelease of mask 20 a from mesh 40 a. Optional one or more tabs 25 areprovided for easy lift-off and removal of mask 20 a. In an alternativeembodiment (not shown) mask 20 a is larger than mesh 40 a and the edgesof mask 20 a can be used as tabs 25.

In operation, assembled device 10 is disposed on tissue or skin having awound with axis 21 approximately aligned with the surgical incision orwound, with the edges of the incision apposed and approximated to eachother. A polymerizable adhesive is then applied onto upper side 22, ontothe whole upper side 22 surface or more preferably only onto/intoopenings 30 on upper side 22. Mask 20 a is then removed and discarded.All of the excess adhesive is removed on mask 20 a. The polymerizableadhesive reacts with the initiator or accelerator of polymerization ifdisposed on the mesh 40, if coated on the mesh 40, and/or if impregnatedinto the mesh 40 resulting in polymerization and bonding of the adhesiveto the skin or tissue and to mesh 40 in the areas of mesh 40corresponding to openings 30. The application of adhesive results inmesh 40 being bonded to the skin and covering the wound or incisionwhile holding skin areas around the dissection in apposed arrangement.Due to presence of the adhesive, mesh 40 is substantially notstretchable in the directions perpendicular to axis 21, keeping thewound or incision closed and skin areas around the dissection in apposedarrangement. At the same time device 10 is stretchable along the mainaxis providing for flexibility in longitudinal direction enablingbending of the underlying joints.

Referring now to FIG. 7, an embodiment of Skin Closure System device isshown which is a combination of the device 10 of embodiments of FIG. 2Aor 4 (shown in FIG. 7A) with mask 20 a (shown in FIG. 7B) of embodimentof FIG. 6 is shown. Skin Closure System device, in this embodiment,comprises a combination of device 10 of embodiment 2A or 4 comprisingtape 20 having a plurality of openings 30 as shown in FIG. 7A withremovable mask 20 a which is shown in FIG. 7B having openings 30 a whichhave substantially similar dimensions and positions and are inregistration with openings 30 on device 10. Mask 20 a is then releasablydisposed on device 10 upper side 22 and can be attached with a weak PSAdisposed on mask 20 a or by a compression fit or by any other methodknown in the art assuring easy release of mask 20 a, with openings 30 ain registration with openings 30. Optionally, one or more tabs 25 areprovided for easy lift-off and removal of mask 20 a. In an alternativeembodiment (not shown) mask 20 a is larger than mesh 40 a and the edgesof mask 20 a can be used as tabs 25.

In operation, assembled Skin Closure System device with device 10 withmask 20 a disposed on upper side 22 is disposed on tissue or skin havinga wound with axis 21 approximately aligned with the surgical incision orwound, with the edges of the incision apposed and approximated to eachother. A polymerizable adhesive is then applied onto mask 20 a surfaceor more preferably only onto/into openings 30 and 30 a. Mask 20 a isthen removed and discarded. All of the excess adhesive is removed onmask 20 a. The polymerizable adhesive reacts with the initiator oraccelerator of polymerization if disposed on the mesh 40, if coated onthe mesh 40, and/or if impregnated into the mesh 40 resulting inpolymerization and bonding of the adhesive to the skin or tissue and tomesh 40 in the areas of mesh 40 corresponding to openings 30. Theapplication of adhesive results in mesh 40 being bonded to the skin andcovering the wound or incision while holding skin areas around thedissection in apposed arrangement. Due to presence of the adhesive, mesh40 is substantially not stretchable in the directions perpendicular toaxis 21, keeping the wound or incision closed and skin areas around thedissection in apposed arrangement. At the same time device 10 isstretchable along the main axis providing for flexibility inlongitudinal direction enabling bending of the underlying joints.

Separate Openings

Referring now to FIG. 8, an embodiment of Skin Closure System device 10is shown, with device 10 comprising a thin, flat, flexible and elastictape 20 elongated along axis 21, with tape 20 having a plurality ofopenings 30 b arranged side by side along the length L and separated bylongitudinal spacer areas 35 and further arranged above and below axis21 and separated by axial spacer areas 36, with no openings 30 boverlapping axis 21. As shown in FIG. 8A, in one embodiment, openings 30b are fully covered by porous mesh 40 with mesh 40 preferably having aninitiator or accelerator of polymerization disposed on the mesh 40,coated on the mesh 40, and/or impregnated into the mesh 40. In analternative embodiment shown in FIG. 8B, openings 30 b have no meshdisposed within the openings, i.e. openings 30 b are comprising cut-outsor holes with no material disposed within openings 30 b. Tape 20 is madeof a polymeric flexible and elastic material. Mesh 40 is made ofpolymeric flexible material, which can optionally also be elastic. Lowerside 23 has optionally a pressure sensitive adhesive (PSA) disposedthereon, which can cover the whole lower side 23, or only a portion oflower side 23 in any pattern.

In use, device 10 is disposed on tissue or skin having a wound with axis21 approximately aligned with the surgical incision or wound, with theedges of the incision apposed and approximated to each other. Apolymerizable adhesive 50 is then applied onto upper side 22, or morepreferably only onto/into openings 30 b on upper side 22 and onto axialspacer areas 36 formed between openings 30 b opposing each other acrossaxis 21, as shown in FIG. 8C. The polymerizable adhesive polymerizesresulting in bonding of adhesive 50 to the skin or tissue and to thedevice 10. Simultaneously, a portion of adhesive 50 a coated on upperside 22 between openings 30 b axial spacer areas 36 forms areas oflesser stretchability and higher rigidity 36 b between openings 30 bopposing each other across axis 21, as shown by hatched line shadowingin FIG. 8C. Portions of adhesive 50 and 50 a can polymerize due toinitiator if disposed on mesh 40, and/or on upper side of tape 20,and/or on upper side of tape 20 in axial spacer areas 36 betweenopenings 30 b. With regards to the embodiment shown in FIG. 8B, wherebyopenings 30 b have no mesh disposed within the openings, thepolymerizable adhesive can be dispensed from a porous tip impregnatedwith initiator or accelerator of polymerization, whereby adhesive reactswith the initiator or accelerator of polymerization, resulting inpolymerization and bonding of the adhesive to the skin or tissue and tothe device 10.

The application of adhesive results in device 10 being bonded to theskin and covering the wound or incision while holding skin areas aroundthe dissection in an apposed arrangement and thereby forming a compositeof the device with the polymerized adhesive. Due to presence of theadhesive, device 10 is substantially not stretchable in the directionsperpendicular to axis 21, keeping the wound or incision closed and skinareas around the dissection in apposed arrangement. At the same timedevice 10 is stretchable along the main axis providing for flexibilityin longitudinal direction enabling bending of the underlying joints,while also providing coverage of the wound or incision. Advantageously,in the embodiments of FIG. 8, no adhesive is in direct contact with thesurgical cut or wound area, which area is positioned substantiallyaligned with axis 21 and under axial spacer areas 36 between openings 30b, resulting in no contact of adhesive with cut tissue.

Variable Width

Referring now to FIG. 9A, an embodiment of Skin Closure System device 10is shown, with openings 30 separated by spacers of varying width,whereby in the middle M of device 10 spacer areas 35 a are wider andtowards the ends spacer areas 35 b are narrower, and close to the endsspacer areas 35 c are narrowest. This results in more stretchabilityaround the center or middle M of device 10 as stretchability is definedby spacer areas 35. Optionally, openings 30 become wider further fromthe center of middle M and close to the ends of device 10, as shown byopenings 31 which are about 2-3 times wider than openings 30 which arecloser to the middle. This results in more stretchability around thecenter or middle M of device 10.

Referring now to FIG. 9B, an embodiment of Skin Closure System device 10is shown, with openings in tape 20 having variable width, with openings32 a narrowest in the middle M of device 10, openings 32 b, 32 c widertowards the ends of the devices, and with openings 32 e close to the endof the device 10 being widest, such as 2-10 times wider vs. openings 32a. This results in more stretchability around the center or middle M ofdevice 10. Spacer areas 35 can be of uniform width, as shown, or ofvarying width (not shown) similar to presented in FIG. 9A.

Slits

Referring now to FIG. 10, embodiments of Skin Closure System device 10are shown, with slits 60 cut into periphery of tape 20. Slits 60 can beof any shape, such as rectangular cuts 60 a or triangular cuts 60 b.Slits 60 can be cut into periphery of tape 20 in the areas betweenopenings 20, as shown in FIG. 10A, or be aligned with openings 30, asshown in FIG. 10B. Slits 60 penetrate tape 20 for about 3% to about 20%of the width W of tape 20, but in no case slits 60 penetrate intoopenings 30. Slits 60 provide for more stretchability of device 10.Slits 60 also allow for some lateral bending of device 10 for non-linearincisions. In some embodiments (not shown) slits 60 are only presentaround center or middle M of tape 20. Slits 60 can also be just on oneside of device 10.

Shapes

In one embodiment, the width W of the device varies along the axis 21.In one embodiment, width W is more narrow in the central region M thanat the ends. In another embodiment, width W is wider in the centralregion M than at the ends.

Referring now to FIG. 11A, an embodiment of Skin Closure System device10 is shown, with openings 30 having concave rectangle or bow-tie shapehaving narrower width closer to axis 21 and wider width further fromaxis 21. Spacer areas 35 have elliptical or rhombus shape or similar,being wider closer to axis 21 and narrower further from axis 21.

Referring now to FIG. 11B, an embodiment of Skin Closure System device10 is shown, with openings 30 having elliptical or rhombus shape orsimilar, having wider width closer to axis 21 and narrower width furtherfrom axis 21. Spacer areas 35 have bow-tie shape or similar, beingnarrower closer to axis 21 and wider further from axis 21. Optimizationof shape of openings 30 and/or spacer areas 35 results in morestretchability around the center or middle M of device 10.

Referring now to FIG. 12, an embodiment of Skin Closure System device isshown, with tape 20 represented by elliptical non-connected islands 20 bof little or no porosity. Islands 20 b can be of varying width. Openings30 are of bow-tie shape and are formed between islands 20 b of mesh 40.

In one embodiment, there are narrow cuts (not shown) in spacer areas 35separating openings 30, the cuts comprising narrow slits in tape 20oriented perpendicular to axis 21 and having length not more than 80% ofwidth W, such as 25, 50%. The cuts can be only between some openings 30or between all openings 30.

Sizes

Tape 20 can be of any elongated shape to cover an articulating joint,such as elliptical, rectangular, and similar. Tape 20 can have ratio oflength to width of about 1:2 to about 1:20, such as 1:5. The length oftape 20 is from about 10 cm to about 50 cm, such as 25 cm. The width oftape 20 is from 2 cm to 10 cm, such 3 cm, 5 cm.

Openings 30 can be rectangular, elliptical, circular, etc., and occupyfrom 30% to 80% of tape 20 area. Width W′ of openings 30 is from 2 mm to12 mm, more preferable 3 mm to 10 mm. The longitudinal dimension orlength L′ of the openings across the width of the tape W is configuredso that openings occupy at least 60% of the tape width W, preferably 60to 100%, more preferably 70-90% of W. Width W′ of openings 30 isconfigured to be at least 5% of L′, preferably 5%-100% of L′, morepreferably at 20-30% of L′.

Porosity of mesh 40 or tape 20 porated areas in openings 30 is definedby size of pores or holes being from about 0.01 mm² to about 4 mm², morepreferably 0.1 mm² to 1 mm². Percent of open area in mesh 40, or ratioof area of holes to area of material surrounding holes within openings30 is from about 95%-about 20%, more preferably 90%-40% constitutingopen area.

PSA

Optional pressure sensitive adhesive bands or stripes are disposed overlower surface 23, (such as shown in FIG. 2) covering from 10% to 90% oflower surface 23. Other shapes and forms of applying pressure sensitiveadhesive are contemplated, including dots, squares, mixed angular bands,etc.

Initiator

In a preferred embodiment, initiators and/or accelerators or ratemodifiers of adhesive polymerization or cross-linking can be releasablydisposed on mesh 40 or releasably incorporated into mesh 40. Forexample, one or more chemical substances may be dispersed in or on mesh40 such as being chemically bound, physically bound, coated, absorbed,or adsorbed to it.

For example, a polymerization initiator or accelerator or rate modifiermay be loaded in or on mesh 40 so that the initiator or rate modifierprovides the desired initiation or rate modification effect to asubsequently applied polymerizable adhesive composition. Thepolymerization initiator or rate modifier may be immobilized in or onmesh 40, so that the initiator or rate modifier does not become detachedfrom mesh 40 and its residues are dispersed in the resultant polymericmaterial. Alternatively, for example, the polymerization initiator orrate modifier may be initially attached to mesh 40, but only in such amanner that it becomes mobilized or solubilized by a subsequentlyapplied polymerizable adhesive composition and dispersed in theresultant polymeric material.

If desired, a combination of chemical substances may also be provided inor on mesh 40, to provide multiple effects. For example, a firstchemical species (such as a polymerization initiator or rate modifier)may be immobilized in or on mesh 40, while a second, different chemicalspecies (such as a bioactive material) may be detachably attached tomesh 40. Other combinations of chemical species and resultant effectsare also envisioned.

When present in or on mesh 40, the chemical substances (i.e.,polymerization initiator, rate modifier, and/or bioactive materials, orother additives), may be incorporated in or on mesh 40 in any suitablemanner. For example, the chemical substance may be added to mesh 40 bycontacting mesh 40 with a solution, mixture, or the like including thechemical substances. The chemical substance may be added to mesh 40, forexample, by dipping, spraying, roll coating, gravure coating, brushing,vapor deposition, or the like. Alternatively, the chemical substance maybe incorporated into or onto mesh 40 during manufacture of mesh 40, suchas during molding.

The polymerization initiator or rate modifier loaded in or on mesh 40may provide a number of advantages for example, so as to provide fasterpolymerization time. The concentration of polymerization initiator orrate modifier may be increased to provide even faster polymerizationtime.

Because the polymerization initiator or rate modifier is loaded directlyin or on mesh 40, it is not necessary to mix the polymerizable adhesivecomposition with a polymerization initiator or rate modifier prior toapplication. This may allow a longer working time, where thepolymerizable monomer composition may be more precisely and carefullyapplied over a longer period of time.

Such suitable initiators are known in the art and are described, forexample, in U.S. Pat. Nos. 5,928,611 and 6,620,846, both incorporatedherein by reference in their entireties, and U.S. Patent Application No.2002/0037310, also incorporated herein by reference in its entirety.Quaternary ammonium chloride and bromide salts useful as polymerizationinitiators are particularly suitable. By way of example, quaternaryammonium salts such as domiphen bromide, butyrylcholine chloride,benzalkonium bromide, acetyl choline chloride, among others, may beused.

Benzalkonium or benzyltrialkyl ammonium halides such as benzyltrialkylammonium chloride may be used. When used, the benzalkonium halide may bebenzalkonium halide in its unpurified state, which comprises a mixtureof varying chain-length compounds, or it can be any suitable purifiedcompound including those having a chain length of from about 12 to about18 carbon atoms, including but not limited to C12, C13, C14, C15, C16,C17, and C18 compounds. By way of example, the initiator may be aquaternary ammonium chloride salt such as benzyltrialkyl ammoniumchloride (BTAC).

Other initiators or accelerators may also be selected by one of ordinaryskill in the art without undue experimentation. Such suitable initiatorsor accelerators may include, but are not limited to, detergentcompositions; surfactants: e.g., nonionic surfactants such aspolysorbate 20 (e.g., Tween 20™ from ICI Americas), polysorbate 80(e.g., Tween 80™ from ICI Americas) and poloxamers, cationic surfactantssuch as tetrabutylammonium bromide, anionic surfactants such as sodiumtetradecyl sulfate, and amphoteric or zwitterionic surfactants such asdodecyldimethyl(3-sulfopropyl)ammonium hydroxide, inner salt; amines,imines and amides, such as imidazole, arginine and povidine; phosphines,phosphites and phosphonium salts, such as triphenylphosphine andtriethyl phosphite; alcohols such as ethylene glycol, methyl gallate;tannins; inorganic bases and salts, such as sodium bisulfate, calciumsulfate and sodium silicate; sulfur compounds such as thiourea andpolysulfides; polymeric cyclic ethers such as monensin, nonactin, crownethers, calixarenes and polymeric-epoxides; cyclic and acycliccarbonates, such as diethyl carbonate; phase transfer catalysts such asAliquat 336; organometallics such as cobalt naphthenate and manganeseacetylacetonate; and radical initiators or accelerators and radicals,such as di-t-butyl peroxide and azobisisobutyronitrile.

Mixtures of two or more, such as three, four, or more, initiators oraccelerators may be used. A combination of multiple initiators oraccelerators may be beneficial, for example, to tailor the initiator ofthe polymerizable monomer species. For example, where a blend ofmonomers is used, a blend of initiators may provide superior results toa single initiator. For example, the blend of initiators can provide oneinitiator that preferentially initiates one monomer, and a secondinitiator that preferentially initiates the other monomer, or canprovide initiation rates to help ensure that both monomer species areinitiated at equivalent, or desired non-equivalent, rates. In thismanner, a blend of initiators can help minimize the amount of initiatornecessary. Furthermore, a blend of initiators may enhance thepolymerization reaction kinetics.

Adhesive

In one embodiment, liquid or semi-liquid adhesive 50 is polymerized oris cross-linking polymerized or is cross-linking after coming in contactwith initiators and/or accelerators of adhesive polymerization and/orcross-linking.

Such initiators and/or accelerators can be coated or disposednon-releasably, i.e. immobilized in or on the mesh 40 while retainingactivity to initiate or accelerate polymerization and/or cross-linking.In one embodiment, initiators and/or accelerators are disposedreleasably, i.e. they can be at least partially released into and mixwith flowing adhesive 50.

In a preferred embodiment, adhesive 50 is polymerized or iscross-linking after coming in contact with initiators and/oraccelerators releasably disposed in or on the mesh 40. Rapidpolymerization and/or crosslinking of adhesive 50 results in bonding ofdevice 10 to tissue.

Adhesive 50 can be any type of biocompatible and rapidly cross-linkableand/or polymerizable compound or mixture of compounds. Rapidlycross-linkable and/or polymerizable means that after initiators oraccelerators are added, or after the adhesive is formed from two or morecomponents, it is capable of curing, i.e. cross-linking and/orpolymerizing within 0.2 min to about 20 min, more preferably within 0.5min to 10 min, such as 1, 2, 3, 5 min.

In one embodiment, adhesive 50 is formed prior to application onto mesh40, for instance by mixing two components contained in separate barrelsor a two-barrel syringe, by passing these two components through amixing tip. In this embodiment, there is no crosslinking initiator oraccelerator disposed inside of mesh 40. In one embodiment, adhesive 50is formed by mixing fibrinogen and thrombin together.

In one embodiment, adhesive 50 comprises fibrinogen, and crosslinkinginitiator or accelerator disposed inside of mesh 40 comprises thrombin.

In a preferred embodiment, the polymerizable adhesive composition maycomprise a polymerizable monomeric adhesive. In embodiments, thepolymerizable adhesive composition comprises a polymerizable1,1-disubstituted ethylene monomer formulation. In embodiments, thepolymerizable adhesive composition comprises a cyanoacrylateformulation. In embodiments, synthetic polymerizable adhesive materialssuch as polyurethane, polyethylene glycol, acrylates, glutaraldehyde andbiologically based adhesives may be used.

Suitable .alpha.-cyanoacrylate monomers which may be used, alone or incombination, include alkyl .alpha.-cyanoacrylates such as 2-octylcyanoacrylate; dodecyl cyanoacrylate; 2-ethylhexyl cyanoacrylate; butylcyanoacrylate such as n-butyl cyanoacrylate; ethyl cyanoacrylate; methylcyanoacrylate or other .alpha.-cyanoacrylate monomers such asmethoxyethyl cyanoacrylate; 2-ethoxyethyl cyanoacrylate; 3-methoxybutylcyanoacrylate; 2-butoxyethyl cyanoacrylate; 2-isopropoxyethylcyanoacrylate; and 1-methoxy-2-propyl cyanoacrylate. In embodiments, themonomers are ethyl, n-butyl, or 2-octyl .alpha.-cyanoacrylate. Othercyanoacrylate monomers which may be used include alkyl estercyanoacrylates, such as those prepared by the Knoevenagel reaction of analkyl cyanoacetate, or an alkyl ester cyanoacetate, withparaformaldehyde, subsequent thermal cracking of the resultant oligomerand distillation.

Many other adhesive formulations can be used and are known to a skilledartisan. For example, mixtures containing PEG succinimidyl glutarate canbe used as a flowable adhesive.

It should be understood that the foregoing disclosure and description ofthe embodiments of the present invention are illustrative andexplanatory thereof and various changes in the size, shape and materialsas well as in the description of the preferred embodiment may be madewithout departing from the spirit of the invention.

We claim:
 1. A system for skin closure, comprising a) an elastic flatflexible tape elongated along a longitudinal axis and having a lowerside, an opposing upper side and a width; said tape having a pressuresensitive adhesive on at least a portion of the lower side; and saidtape having a plurality of openings having a length and an openingswidth and arranged side-by-side and across said longitudinal axis withspaces between said openings oriented across the longitudinal axis andwherein said length of the openings is at least 60% of the width of thetape and wherein the openings width is at least 5% of the length of theopenings; and b) a polymerizable adhesive, wherein application of thepolymerizable adhesive onto the openings renders said devicesubstantially not stretchable in the direction perpendicular to thelongitudinal axis to keep a wound or an incision closed and skin areaaround the wound or incision in apposed arrangement, but stretchable inthe direction along the longitudinal axis.
 2. The system of claim 1,wherein said tape is elastically stretchable lengthwise from 3% to 25%of length under 1 N of force.
 3. The system of claim 1, wherein theopenings comprise a porous mesh and said spaces between said openingsare non-porous.
 4. The system of claim 3, wherein said tape comprises anelastic substrate forming said upper side attached to a flexible elasticmesh forming said lower side.
 5. The system of claim 3, wherein saidmesh is elastic.
 6. The system of claim 3, wherein said mesh is formedby porating or perforating said tape.
 7. The system of claim 3, whereinan initiator or accelerator of polymerization or cross-linking isdisposed on or in the mesh.
 8. The system of claim 7, wherein theaccelerator or the initiator comprises a quaternary ammonium salt. 9.The system of claim 1, wherein said openings comprise elongatedsubstantially rectangular or elliptical or bow-tie shapes.
 10. Thesystem of claim 1, wherein the spaces between said openings are largerin a center of said tape.
 11. The system of claim 1, wherein the widthof said openings is smaller in a center of said tape.
 12. The system ofclaim 1, wherein the tape further comprises slits in a periphery of saidtape, said slits arranged between said openings.
 13. The system of claim1, further comprising a removable mask having mask openings withsubstantially similar dimensions and positions as the openings on thedevice, the mask releasably disposed on the upper side, with the maskopenings in registration with the openings on the device, and the maskfurther having one or more tabs configured for grasping for lift-off andremoval of the mask from the device.
 14. The system of claim 1, furthercomprising a composite of said tape and said adhesive wherein saidadhesive is present in at least said openings.
 15. A kit comprising thedevice of claim 1, and a container with polymerizable adhesive having atip for expressing said polymerizable adhesive, wherein said tip has awidth equal to or smaller than a width of said openings.
 16. The systemof claim 15 wherein the adhesive comprises cyanoacrylate monomers,fibrinogen, or PEG succinimidyl glutarate.
 17. A method of skin closure,comprising the steps of: a) disposing the device of claim 1 onto skinhaving a surgical incision with the longitudinal axis approximatelyaligned with the surgical incision; b) approximating edges of theincision to each other while using the pressure sensitive adhesive tofixate the device of claim 1 on skin; c) applying a polymerizableadhesive onto the upper side and into the openings; and d) allowing thepolymerizable adhesive to polymerize and bond to skin and to the deviceof claim 1, wherein the device of claim 1 is substantially notstretchable in the directions perpendicular to the longitudinal axis butstretchable along the longitudinal axis providing for flexibility andenabling bending of underlying joints.